Pharm - dementia

Question 1

Medications that can cause cognitive impairment/ delirium (4 classes)?

Answer 1

Antiemetics/ anti-vertigo agents → dimenhydrinate, promethazine, scopolamine

Antihistamines → diphenhydramine, hydroxyzine

Antipsychotics → chlorpromazine, clozapine, olanzapine

Hypnotics - all

Question 2

Drug class that can contribute to dementia?

Answer 2

Antidepressants → TCA most sig.
-(amitriptyline, clomipramine, desioramine, done-in, imipramine, nortriptyline, paroxetine)

Question 3

Drugs that can contribute to both cognitive impairment + dementia? (2 classes)

Answer 3

Antimuscarinics → darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine

Hypnotics → all sedative hypnotic can contribute to impairment (zolpidem, zopliclone) BUT benzodiazepines may increase risk of dementia!

Question 4

2 drugs classes to manage dementia?

Answer 4

1. Cholinesterase inhibitor
2. NMDA R antagonist

Question 5

Example of a cholinesterase inhibitor?

Answer 5

Donepezil

Question 6

Example of a NMDA R antagonist?

Answer 6

Memantine

Question 7

What drug:
Block the metabolism of Ach within synaptic cleft → ↑ Ach → ↑ cholinergic transmission

Answer 7

Donepezil (cholinesterase inhibitor)

Question 8

What drug:
Block glutamate-induced neuronal excitotoxicity
(final common pathway in neuronal death)

Answer 8

Memantine
(NMDA R Antagonist)

Question 9

What drug is indicated in all seventies of AD + other dementia causes?

Answer 9

Donepezil
(Cholinesterase Inhibitor)

Question 10

What drug is indicated in mild-moderate AD and not used as a monotherpy unless others have failed or in combo to help with severe disease

Answer 10

Memantine
(NMDA R Antagonist)

Question 11

Headache, nausea, diarrhea -most common (10%)
- vomiting, anorexia/ weight loss, vivid dreams, tremor, vertigo, other cholinergic effects (rhinorrhea, ↑ urinary freq.)

Conflicting evidence on cardiac safety profile – small risk of QT interval prolongation

Answer 11

Donepezil
(Cholinesterase Inhibitor)

Question 12

Well tolerated

Dizziness (7%), headache (6%), confusion (6%), constipation (5%), nausea/vomiting (3%)

Answer 12

Memantine

(NMDA R Antagonist)

Question 13

Donepezil 3 most common adverse side effects?

Answer 13

Headache, nausea, diarrhea -most common (10%)

Question 14

Drug classes used for responsive behaviours in dementia (5)?

Answer 14

1. antidepressants (SSRIs)
2. antipsychotics (Risperidone, olanzapine)
3. cholinesterase inhibitors
4. NMDA R antagonist
5. Benzodiazepines

Question 15

for treatment of agitation/ psychosis in dementia pts when symptoms are severe, dangerous, or cause sig. distress

Answer 15

Antipsychotics (Risperidone, olanzapine)